Business Case for the Application of Lean Design at XYZ, Inc.

This field project is an exercise in developing change in a business where aging strategies threaten the competitiveness of the business as a whole. Research and analysis into the market, for XYZ, Inc., are used to build the case that the market has changed. Old methods of competing are no longer effective at maintaining the market lead. Recent loss of the market lead is direct evidence that the company has not been paying attention to the low-end of the market and that a new strategy is needed. The current method of Lean Design is explored as it relates to revitalizing businesses, without the higher risk of new product development. Exploring the history and expert commentary of Lean Enterprise helps the reader develop insight into the correct way to achieve positive results for a business and how to avoid common pitfalls. To help XYZ executive management understand the benefits of Lean Design, a pilot project is proposed. Two project approaches will be addressed. The first project, Project A, is the first impression method, which explores the expected question of: Why not implement the change on all Appliance-A products? The purpose of addressing Project A before jumping to the best solution is to preemptively prevent the project from starting off on a high-risk path. The second project, Project B, is the best-result method, which explores the lowest-risk with highest-gain approach. Creating a small win for the business, without risk, should pave the way for a positive improvement in the organization and allow for a strategy, which could lead to an eventual recovery in the market. Operational metrics combined with project estimates clearly shows that capital investment for these projects will be recovered quickly. Sensitivity analysis for the projects shows which elements are the most critical. Finally, an intuitive understanding of the project risks directs a clear path for the best choice. Implementation of Lean Enterprise is a complex endeavor and requires efforts that transcend this business case. The final portion of this field project points out several areas where further research and analysis could augment a fuller more complete implementation of Lean Enterprise

Implementation of Standardized Handoff Report in the Post Anesthesia Care Unit

BACKGROUND: Handoff communication is a critical event as it involves the transfer of patient details, authority, and responsibility from one clinician to another. The variations in handoff can lead to increased opportunities for clinician error due to the distinct possibility of the anesthesia providers omitting critical patient information. LOCAL PROBLEM: The site for this quality improvement project is an academic medical center in the Southeastern region. The purpose of this quality improvement project was to implement a standardized anesthesia handoff tool for anesthesia providers. The aim of this project was after one month of implementation, the mean anesthesia handoff time will decrease from 70 seconds to 55 seconds and anesthesia handoff will be 65% complete using the WHAT tool. METHODS: The Johns Hopkins’s Evidence-Based Practice model was used as the framework for this project. Education was provided to all anesthesia providers regarding the project design and description of the tool. The outcome measures for data collection included mean handoff time and completeness of the handoff tool pre- and post-implementation. INTERVENTIONS: The SRNA project team members observed and recorded the handoff that occurred between the anesthesia providers pre- and post-implementation. The completeness of the WHAT tool and handoff time data was compiled and analyzed. RESULTS: The average recorded time it took to complete hand off decreased from 67.9 seconds to 48.9 seconds post implementation, which met our aim. When looking at completed tools turned in over the entire course of the project, the completeness of the tool rose from 3.8/8 (or 47.5%) to 6.4/8 (or 80%), which also surpassed our aim. CONCLUSIONS: The results produced from the project showed that the implementation of a standardized handoff tool has positive impacts on the handoff process. When considering the improved efficiency and the low economic impact of the handoff tool, the tool can feasibly be integrated into the standard of care

Characterization of Archaeal Community in Contaminated and Uncontaminated Surface Stream Sediments

Archaeal communities from mercury and uranium-contaminated freshwater stream sediments were characterized and compared to archaeal communities present in an uncontaminated stream located in the vicinity of Oak Ridge, TN, USA. The distribution of the Archaea was determined by pyrosequencing analysis of the V4 region of 16S rRNA amplified from 12 streambed surface sediments. Crenarchaeota comprised 76% of the 1,670 archaeal sequences and the remaining 24% were from Euryarchaeota. Phylogenetic analysis further classified the Crenarchaeota as a Freshwater Group, Miscellaneous Crenarchaeota group, Group I3, Rice Cluster VI and IV, Marine Group I and Marine Benthic Group B; and the Euryarchaeota into Methanomicrobiales, Methanosarcinales, Methanobacteriales, Rice Cluster III, Marine Benthic Group D, Deep Sea Hydrothermal Vent Euryarchaeota 1 and Eury 5. All groups were previously described. Both hydrogen- and acetate-dependent methanogens were found in all samples. Most of the groups (with 60% of the sequences) described in this study were not similar to any cultivated isolates, making it difficult to discern their function in the freshwater microbial community. A significant decrease in the number of sequences, as well as in the diversity of archaeal communities was found in the contaminated sites. The Marine Group I, including the ammonia oxidizer Nitrosopumilus maritimus, was the dominant group in both mercury and uranium/nitrate-contaminated sites. The uranium-contaminated site also contained a high concentration of nitrate, thus Marine Group I may play a role in nitrogen cycle